Endodontic treatment of teeth. Stages of endodontic treatment

Human teeth require special care throughout life. Because of their condition depends on the health of our internal organs, in particular the intestines. They can both save us from infections, and be a hotbed of it. Particular discomfort brings us a sick tooth. We feel pain at the slightest hit of cold or hot food, sweet or salty. When the pain begins in the teeth, you should immediately contact a dentist, since obvious symptoms may indicate a neglected stage of the disease inside the tooth. In this case, special methods of therapy are used, one of which is endodontic treatment.

Section of dentistry - endodontics

Endodontics is the direction of therapeutic dentistry, focused on the treatment of inflammatory diseases of tooth pulp and tissues surrounding the tops of the roots - periodontium. The term "endodontics" comes from two words: "endo", which means "inside", and "odont" - "tooth."

What is endodontic intervention?

Endodontic treatment is a complex of successive stages of treatment aimed at preserving the tooth. In case of occurrence of such common complications of caries, as pulpitis or periodontitis, it is necessary to work directly inside the tooth. The complexity of this treatment is that the internal volume of the tooth can be extremely small, the lumen of the root canals is often so narrow that it is difficult even to detect it. If the roots are curved, and the tooth is tilted, opening the mouth for any reason is limited, endodontics becomes the highest aerobatics of modern dentistry. It requires a huge experience and intuition from the dentist, possession of a variety of high-tech methods of diagnosis and treatment.

Endodontic dentistry - indications

Indications for this treatment are:

1. All types of pulpitis, not subject to biological, conservative treatment.
2. Acute and chronic periodontitis.
3. The need for retreatment after previous endodontic treatment.
4. Preparation of the tooth for prosthetics with cultured inserts.
5. Preparation for prosthetics with crowns that require significant grinding of the hard tissues of the teeth (including with a significant tilt or extension of the tooth from the jaw).
6. Endodontic treatment is also indicated when preparing the tooth for intracanal bleaching.
7. Treatment of a fracture of the tooth, leading to a trauma to the pulp or its death.

Are there any contraindications to this procedure?

Contraindications to endodontic treatment of root canals can be divided into two groups: absolute and relative.

Absolute contraindications:

• Periodontal lesions that do not allow the tooth to be retained;
• If the tooth is to be removed for other reasons (supercomplex, with an incorrect location in the dentition and not subject to orthodontic treatment, with rapid removal of the tooth according to orthodontic indications, etc.);
• Longitudinal fracture of the root of the tooth ;
• Presence of a cyst that is not subject to conservative or surgical treatment, or other education in the area of the root of the tooth (osteomyelitis, oncology, etc.);
• The severe general condition of the patient is also a contraindication to such manipulation as endodontic treatment of canals.

Relative contraindications:

• Significant curvature of the root canals;
• Obstruction of the root canals (absence of lumen, presence of hard-to-extract fillings);
• Presence in the lumen of the root canal of foreign objects, for example, fragments of tools;
• Perforation of the root walls;
• The patient's conflict, his reluctance to heal the tooth.

The goals that the doctor pursues in carrying out this manipulation

The tasks facing the dentist during his endodontic treatment of the root canals can be divided into the following areas:

1. Provision of sterility of used tools and materials.
2. Isolation of a sick tooth from saliva during work.
3. Qualitative partial or complete removal of inflamed pulp or complete elimination of its decay.
4. Fighting the pathogenic microflora inside the tooth and behind the tips of the roots.
5. Quality and safe expansion of root canals.
6. Complete filling of root canals in their entire volume, temporary or permanent.
7. Quality control of treatment at all its stages.

Preparation for such treatment

When preparing for endodontic treatment of canals, it is necessary to conduct a full-fledged examination: to diagnose and plan the stages of the forthcoming intervention. It is mandatory to study a preliminary X-ray. The received information should be intelligibly communicated to the patient. After he understands all the important points of the upcoming treatment, the patient signs a document on informed consent.

It is also important to make sure beforehand that the patient has no contraindications to the various stages of the forthcoming treatment, especially to anesthesia. In the absence of reliable information on the lack of an allergy to anesthetics, it is necessary to conduct an allergy test, sending the patient to an allergist.

How is endodontic treatment performed?

Treatment carried out inside the tooth should be carried out exclusively by physicians who have undergone specialized training, confirmed by the appropriate certificate. When choosing the method of anesthesia, the doctor must choose the most effective drug taking into account the possible features of the patient's body - the presence of pregnancy or diseases of the cardiovascular system, allergies to specific medications and so on.

During treatment, the doctor continuously observes the general condition of the patient, he must be ready at any time to interrupt the basic treatment for emergency care.

It is very important to use additional methods of diagnosis and therapy during treatment. The use of a viziograph or apexlocator allows qualitatively treating root canals, minimizing the risk of injury to the walls of the root and tissues around the tips of the roots, under- or over-repair of canals,

It is mandatory to warn the patient about the possibility of various complications and discomfort after treatment. It is desirable that these explanations are given before the procedure begins, this will help the patient decide on the appropriateness of the intervention and will give more confidence to the doctor's actions.

Stages of treatment

All stages of endodontic treatment can be divided into three steps:

1. Preparing access to the root canals. At this stage, anesthesia, excision of all non-viable tissues of the carious cavity is carried out, constant antiseptic treatment is carried out.
2. Work in the root canals, preparing them for permanent sealing. The doctor finds the entrance to the root canals, removes their contents, including the infected layer from the walls, increases the lumen of the canals for the possibility of further sealing. The constant presence of an antiseptic solution in the lumen of the root canals during endodontic treatment is strictly necessary!
3. After the elimination of inflammation and the washing out of various contaminants, the root canals are sealed. The method of filling depends on the diagnosis and qualification of the doctor. Upon completion of work, a control X-ray should be taken. The choice of the method for further restoration of the external part of the tooth is discussed with the patient in addition.

Treatment of periodontitis

Endodontic treatment of periodontitis implies one more stage - zapakalnuyu therapy. After the preparation of the root canals, a medicinal preparation temporarily placed within the apical foramen, capable of effectively combating the infection, is temporarily placed in them for sealing. The most frequently used for this purpose are preparations based on calcium hydroxide.

In case of complication of periodontal inflammation by the formation of granulomas or cysts, the medication can be repeated several times. If necessary, in addition to endodontic treatment, operative removal of the apex of the root of the tooth and the walls of the cyst.

Complications of manipulation

The most common complications in endodontic treatment are the following:

1. Fracture of the instrument in the lumen of the root canal.
2. Perforation of the root wall.
3. An additional root channel is not detected.
4. Insufficient passage of the root canal.
5. Nedoplombirovka root canal or excessive excretion of the filling material beyond the root.
6. Incomplete filling of the lumen of the root canal, leading to resorption of the root filling.
7. Appearance of pain and / or swelling after treatment.

If there are complaints or if these complications are detected, repeated endodontic treatment is indicated. In the warranty period specified in the contract, retreatment is free. Repeated treatment can be carried out both in full and partially, with refilling only those channels in which abnormalities are found.